Dysmenorrheic Patients Research Articles

A Comparison of Pain Scores in Dysmenorrheic Patients With or Without Dyspeptic Symptoms.

Introductıon: Dysmenorrhea attacks may be accompanied by extragenital symptoms such as nausea, vomiting, diarrhea, headache and leg pain and by emotional symptoms such as tension and irritability. Therefore, we think that dysmenorrheic symptoms may be more severe in patients with dyspeptic symptoms. The purpose of this study was to determine whether pain scores would differ between dysmenorrheic patients with or without dyspeptic symptoms.Methods: Patients presenting to the emergency department with dysmenorrhea attacks and volunteering to participate were included in this case-control study. Subjects with dyspeptic symptoms were enrolled as the case group and those without dyspeptic symptoms were enrolled as the control group. Participants were administered the Faces Pain Scale and a questionnaire involving demographic characteristics.Results: Pain scores on arrival were higher in the case group than in the control group (4.20 ± 0.71, 3.70 ± 0.74, n=30, p=0.011). A significant difference was observed between pain scores on arrival and at discharge in both the control and case groups. A decrease in pain scores was determined in all the subjects in the case group, while no change was observed in three volunteers in the control group.Conclusions: We conclude that pain is significantly more severe in dysmenorrheic patients with dyspeptic symptoms.

Endometrial biopsy is an important diagnostic tool for the evaluation of abnormal uterine bleeding

In this study 100 biopsies were taken from the endometrium of childbearing women (18-50 yrs. of age) suffering from abnormal vaginal bleeding from Jan 2019-Dec 2019. Endometrial Biopsy (EB) is safe, an outpatient procedure, low cost, carries out without general anesthesia & the incidence of hemorrhage, infection & uterine perforation are less common than with D&C. EB is an alternative to dilatation & curette (D&C) for the evaluation of infertile & abnormal vaginal bleeding or dysmenorrheic patients. There are two main groups of causes to irregular vaginal bleeding. 1. Organic disease (74% of the cases), in this group there are obvious lesion such as, endometrial polyp, endometrial hyperplasia & chronic endometritis. The most common cause was endometrial hyperplasia 48%, it is commonly seen during the perimenopausal period (40-50yr). Less common causes include chronic endometritis 8%, hydatidiform mole 7%, and endometrial polyp 7%. 2. non-organic disease comprises 19% of all cases, anovulatory period 13% or Luteal phase insufficiency 6%. They are commonly seen from age of 18-40yrs. 6% of the cases found to have normal endometrium. 5 endometrial biopsies were inadequate & unsatisfactory for histopathological interpretation. The aim of this study is to evaluate the usefulness & disadvantages of EB & to compare it with the traditional method of endometrial curette.

Effect of traditional Chinese medicine formula GeGen decoction on primary dysmenorrhea: A randomized controlled trial study

Ethnopharmacological relevanceGeGen Decoction, a well-known Chinese herbal formula, is widely used in China and other Asian countries to treat gynecological diseases, including primary dysmenorrhea. Pharmacological studies have confirmed that GeGen Decoction is able to inhibit spasmodic contractions of the uterus in vivo and in vitro. Aim of the studyThe objective of this study is to examine the efficacy and safety of GeGen Decoction on primary dysmenorrheic patients. MethodsThis was a randomized, double-blinded, placebo-controlled trial. GeGen Decoction or placebo was administered a week before the expected start of each cycle for three consecutive menstrual periods. Between-group differences in pain intensity were detected by visual analogue scale (VAS). In addition, serum levels of arginine vasopressin (AVP) and estrogen (E) were examined by enzyme-linked immunosorbent assay. Metabolomic analysis was further used to evaluate the influence of GeGen Decoction on the metabolomics of primary dysmenorrheic patients. ResultsA total of 71 primary dysmenorrheic women were recruited and 30 participants met the criteria were randomized into GeGen Decoction or placebo group. After three consecutive menstrual cycles’ treatments, the VAS score of the GeGen Decoction group was significantly lower than that of the placebo group. Both serum levels of AVP and E decreased after GeGen Decoction administration, while the placebo seemed to have little effect on either of the index. Moreover, after GeGen Decoction treatment, seven important metabolites were identified by metabolomic analysis compared to the placebo group. No abnormalities in blood biochemical and routine physical examination pre and post GeGen Decoction intervention were observed. ConclusionsGeGen Decoction can remarkably relieve the severity of menstrual pain without obvious adverse effects. Its therapeutic effect on primary dysmenorrhea might be related to the regulation of pituitary hypothalamic ovarian hormones, and interfering with the metabolic change.

The impact of circulating 25-hydroxyvitamin and oral cholecalciferol treatment on menstrual pain in dysmenorrheic patients

This study aims to determine Vitamin-D level in patients with primary dysmenorrhea and investigate the effect of Vitamin-D replacement on symptoms. About 100 patients in the 18–30 age group followed-up with primary dysmenorrhea diagnosis were included in this observational study. The pain severity was assessed using the visual analog scale (VAS). 25-hydroxy vitamin D(25(OH)D) levels of the patients were measured and the replacement therapy was applied according to measurement results. The patients were followed for three months in total. At the end of the three-month period, the 25(OH)D level was measured and the VAS score was assessed once more after the therapy. 25(OH)D level was insufficient in 23.0%, deficient in 45.0%, and severely deficient in 32.0% of the patients. It was found that the VAS score increased as the 25(OH)D level decreased (r = −0.320; p = .002). A significant reduction was observed in VAS scores after Vitamin-D treatment in all three groups; the amount of reduction in VAS score was determined to be higher in the patients with severely deficient levels of 25(OH)D, compared to the patients with deficient or insufficient levels (p < .001). A significant and negative correlation was found between Vitamin-D and symptoms associated with dysmenorrhea in our study. The Vitamin-D replacement therapy led to a significant decrease in symptoms.

Abdominal skeletal muscle activity precedes spontaneous menstrual cramping pain in primary dysmenorrhea

Dysmenorrhea is a pervasive pain condition that affects 20-50% of reproductive-aged women. Distension of a visceral organ, such as the uterus, could elicit a visceromotor reflex, resulting in involuntary skeletal muscle activity and referred pain. Although referred abdominal pain mechanisms can contribute to visceral pain, the role of abdominal muscle activity has not yet been investigated within the context of menstrual pain. The goal of this study was to determine whether involuntary abdominal muscle activity precedes spontaneous episodes of menstrual cramping pain in dysmenorrheic women and whether naproxen administration affects abdominal muscle activity. Abdominal electromyography activity was recorded from women with severe dysmenorrhea (n= 38) and healthy controls (n= 10) during menses. Simultaneously, pain was measured in real time using a squeeze bulb or visual analog rheostat. Ninety minutes after naproxen administration, abdominal electromyography activity and menstrual pain were reassessed. As an additional control, women were also recorded off menses, and data were analyzed in relation to random bulb squeezes. Because it is unknown whether mechanisms of menstrual cramps are different in primary or secondary dysmenorrhea/chronic pelvic pain, the relationship between medical history and abdominal muscle activity was examined. To further examine differences in nociceptive mechanisms, pressure pain thresholds were also measured to evaluate changes in widespread pain sensitivity. Abdominal muscle activity related to random-bulb squeezing was rarely observed in healthy controls on menses (0.9 ± 0.6 episodes/hour) and in dysmenorrhea participants off menses (2.3 ± 0.6 episodes/hour). In dysmenorrheic participants during menses, abdominal muscle activity frequently preceded bulb squeezing indicative of menstrual cramping pain (10.8 ± 3.0 episodes/hour; P < .004). Whereas 45% of the women with dysmenorrhea (17 of 38) had episodes of abdominal muscle activity associated pain, only 13% (5 of 38) had episodes after naproxen (P= .011). Women with the abdominal muscle activity-associated pain were less likely to have a diagnosis for secondary dysmenorrhea or chronic pelvic pain (2 of 17) than women without this pain phenotype (10 of 21; P= .034). Similarly, women with the abdominal muscle activity-associated pain phenotype had less nonmenstrual pain days per month (0.6 ± 0.5) than women without the phenotype (12.4 ± 0.3; P= .002). Women with abdominal muscle activity-associated pain had pressure pain thresholds (22.4 ± 3.0 N) comparable with healthy controls (22.2 ± 3.0 N; P= .967). In contrast, women without abdominal muscle activity-associated pain had lower pressure pain thresholds (16.1± 1.9 N; P= .039). Abdominal muscle activity may contribute to cramping pain in primary dysmenorrhea but is resolvable with naproxen. Dysmenorrheic patients without cramp-associated abdominal muscle activity exhibit widespread pain sensitivity (lower pressure pain thresholds) and are more likely to also have a chronic pain diagnosis, suggesting their cramps are linked to changes in central pain processes. This preliminary study suggests new tools to phenotype menstrual pain and supports the hypothesis that multiple distinct mechanisms may contribute to dysmenorrhea.

Effect of short-term, low-dose treatment with tamoxifen in patients with primary dysmenorrhea

Current treatment of painful periods and other symptoms related to primary dysmenorrhea (PD) is usually commenced with non-steroidal anti-inflammatory drugs or oral contraceptives, which fails in about 10% of affected patients. Tamoxifen, a selective estrogen-receptor modulator (SERM), has been demonstrated to directly inhibit uterine contractions, causing improvement in uterine blood flow. It could be considered for application in selected groups of dysmenorrheic patients, for instance carriers of breast cancer-associated antigen (BRCA) genes, breast cancer survivors or women with advanced endometriosis. Thus the aim of the present study was to investigate the effect of short-term treatment with tamoxifen on PD and PD-related symptoms, as well as its direct effect on parameters of intrauterine pressure during the painful menstruation, in a group of dysmenorrheic patients. After two cycles of administration of tamoxifen we noted a significant decrease in bleeding together with reductions in the severity of menstrual cramps, diarrhea, headache, fatigue and anxiety. In intrauterine pressure assessments, tamoxifen significantly decreased propagation of uterine contractions. In conclusion, SERMs such as tamoxifen may constitute a therapeutic option in selected groups of patients, improving dysmenorrheic symptoms. Additionally to its receptor-mediated effects, tamoxifen was shown to exert a direct influence on uterine contractile activity that may explain the decrease of menstrual pain and cramps noted in the studied group.

Analysis of uterine contractility after administration of the non-steroidal antiinflammatory drug nimesulide

To study the effects of non-steroidal anti-inflammatory drugs (NSAIDs) on uterine contractility in different parts of the uterus and on the direction and velocity of propagation of the activity, intra-uterine pressure (IUP) was measured simultaneously in 10 dysmenorrheic and 5 eumenorrheic patients with two microtransducer catheters at two locations (30 mm apart) before and after taking nimesulide, a newly developed NSAID. The uterus developed higher pressure cycles in the fundus than in the isthmus, in both eumenorrheic and dysmenorrheic conditions. Nimesulide did not affect either the active pressure (AP) or the direction and velocity of propagation of the activity, though it alleviated pain significantly. In dysmenorrheic patients, resting pressure (RP) is at a high level only in the fundus. The velocity of propagation ranged from 12 to 19 mm/s. The mathematical probability of procervical activity (1.0 if all procervical; 0.0 if all profundal), and thus the transport, was 0.59 in eumenorrheic and 0.68 in dysmenorrheic patients, the average for the whole series being 0.65. The luminal content (menstrual blood) moves in the cervical direction much more slowly than would be expected on the basis of simple calculations of velocity (velocity vector) of propagation.

Contribution to the pathogenesis of dysmenorrhea.

Menstrual blood was collected from five eumenorrheic and seven dysmenorrheic women aged between 20 and 35 years for a period of three cycles each. The levels of prostaglandin F2 alpha (PGF2 alpha), prostaglandin E2 (PGE2), 6-keto-prostaglandin F1 alpha (6-k-PGF1 alpha)-the stable metabolite of prostacyclin (PGI2)-, oestradiol, oestrone, and progesterone were determined radioimmunologically. Both eumenorrheic and dysmenorrheic women showed identical blood losses. The levels of oestradiol excreted by the dysmenorrheic women were markedly elevated as compared to the non-dysmenorrheic subjects (2 p less than 0.05). Oestrone excretion was in the same order of magnitude in all subjects examined. The concentration of progesterone per menstruation was significantly higher in the eumenorrheic women (2 p less than 0.02) than in the dysmenorrheic patients. Menstrual excretion of PGF2 alpha was 2.5 times higher in the dysmenorrheic women compared to the normal subjects (2 p less than 0.05). The levels of PGE2 was identical in both groups. Excretion of 6-k-PGF1 alpha was significantly lower in the dysmenorrheic women than in the eumenorrheic subjects (2 p less than 0.02). The oestradiol/progesterone ratio showed a distinct predominance of oestradiol in the dysmenorrheic patients. PGF2 alpha dominance in the dysmenorrheic patients is expressed by the PGF2 alpha/6-k-PGF1 alpha and the PGF2 alpha/PGE2 ratios. A shift in the oestradiol/progesterone ratio in favour of oestradiol seems to be the underlying pathogenic principle of dysmenorrhea. The oestradiol dominance is associated with a shift in the PGF2 alpha/PGI2 and the PGF2 alpha/PGE2 proportions. Thus, the PGF2 alpha predominance and a simultaneous reduction of PGI2 in uterine tissue seem to be responsible for dysmenorrheic bleeding.

Prostaglandins and the non-pregnant uterus. The pathophysiology of primary dysmenorrhea.

The biochemical background of primary dysmenorrhea is characterized by high uterine prostaglandin levels, high levels of blood arginine vasopressin and of estradiol in the late cycle. In dysmenorrheic patients the progesterone level is slightly higher when bleeding starts, than in eumenorrheic patients, but is normal during the late cycle. Biochemical actions pass through free 'activator' calcium, and this, together with possible micro-anatomic changes (like increased frequency of gap junctions), explains the smooth-muscle dysfunction. The uterine activity is characterized by high conduction velocity (as indicated by the high rate of rise in active pressure) and by high resting pressure. The pathophysiology of primary dysmenorrhea includes diminished uterine blood flow and anoxic pain, which result from the constriction of the uterine arteries and/or from the contracture on the uterine muscle itself.

Aspects of inhibition of myometrial hyperactivity in primary dysmenorrhea.

Uterine hypercontractility is considered to be an important factor in primary dysmenorrhea. A survey is given on possible mechanisms controlling the cytoplasmic concentration of free calcium and thereby contractile activity in the myometrial smooth muscle cell. Probably acting by different modes of action, inhibitors of prostaglandin synthesis, calcium antagonists and beta 2 stimulators have all been shown to reduce myometrial activity and relieve dysmenorrheic pain. The possibility of achieving further uterine relaxation after initial treatment with prostaglandin inhibitors by adding a calcium antagonist such as nifedipine is discussed. It is also suggested that when utilizing a reliable pressure recording technique in the evaluation of dysmenorrheic patients, the pronounced myometrial relaxation obtained by such combined therapy may be of diagnostic value.

Prostaglandins in primary dysmenorrhea: Comparison of prophylactic and nonprophylactic treatment with ibuprofen and use of oral contraceptives

Prostaglandin synthetase inhibitors have been used in clinical trials for the treatment of primary dysmenorrhea on the theory that the disorder may be caused by a high level of prostaglandins. However, a causal role of prostaglandin in dysmenorrhea has not been established, and there is only indirect evidence that the amelioration of dysmenorrhea by prostaglandin synthetase inhibitors is related to their inhibition of prostaglandin synthesis in the uterus. We, therefore, monitored menstrual prostaglandin release in 14 dysmenorrheic patients in a controlled, double-blind, cross-over trial of ibuprofen (Motrin®) and in two dysmenorrheic subjects while they were receiving oral contraceptive therapy and while they were not. A total of 89 menstrual cycles were studied. We found that ibuprofen therapy reduced menstrual prostaglandin release and relieved dysmenorrhea but that placebo therapy did not. Oral contraceptives decreased menstrual flow, reduced prostaglandin release and also alleviated dysmenorrhea. We conclude that primary dysmenorrhea is related to a high level of menstrual prostaglandin release. Ibuprofen inhibits prostaglandin synthesis whereas oral contraceptives inhibit ovulation and cyclic endometrial development. Thus, the two drugs suppress endometrial prostaglandin through different mechanisms. Reduction of menstrual prostaglandin release leads to alleviation of dysmenorrhea.

Mefenamic Acid for Dysmenorrhea in Patients With Intrauterine Devices

Telephone interviews with 12 patients (11 had Progestasert IUDs; 1 had copper 7 IUD), who were suffering from dysmenorrhea, were conducted to determine the effects of mefenamic acid in dysmenorrheic patients using IUD. Average duration of IUD use was 16 months (range, 6-30 months). 9 patients suffered from menstrual cramps before IUD insertion; 3 suffered from cramps after insertion. 5 started using mefenamic acid for menstrual cramps before IUD insertion, while the other 7 started after insertion. Average duration of use of mefenamic acid for menstrual cramps was 9 months (range, 1-24 months), with doses ranging from 2 to 12 capsules/menstrual cycle. Of 10 patients previously taking analgesics for menstrual cramps, 9 reported mefenamic acid as better. None reported any change in amount of menstrual flow. All patients reported complete or nearly complete relief of cramps after taking mefenamic acid. Mefenamic acid was also found to be effective in relieving other menstrual symptoms such as leg pain, backache, nausea, and increased bowel movement. Mefenamic acid is effective because it not only inhibits formation of contraction-causing prostaglandins and its synthetase, but also blocks contraction of the uterine muscle to remaining prostaglandin intermediates. Scientifically controlled studies should be done to substantiate these findings.

Suppression of uterine activity by prostaglandin synthetase inhibitors.

During hypertonic saline induction, the evolution of intrauterine pressure, the oxytocin response and abortion were delayed in naproxen-treated patients. The PG synthesis inhibitors naproxen, mefenamic acid and ibuprofen decreased the high uterine resting pressure ('tone'), the frequency of contractions but not always the active pressure ('amplitude') in dysmenorrheic patients, with a coincident decrease in pain. The naproxen-sodium treatment decreased prostaglandins F and E in menstrual blood and uterine jet washings by 60--80 per cent.

The effect of ibuprofen on the intrauterine pressure and menstrual pain of dysmenorrheic patients

In 12 dysmenorrheic patients we examined the therapeutic action of the Prostaglandin-synthesis inhibitor: Ibuprofen, a non-steroidal analgesic agent. Ibuprofen highly significantly reduced the resting pressure (P<0.001), active pressure (P<0.001) and frequency (P<0.05) of cyclic activity of the uterus, as well as menstrual pain (P<0.001). Since these effects occurred after a single oral dose of 800 mg Ibuprofen, without side effects or complications, extensive field trials are recommended with this and other PG-synthesis inhibitors, to assess their therapeutic benefits.

The effect of naproxen-sodium on the intrauterine pressure and menstrual pain of dysmenorrheic patients

The Prostaglandin-synthesis inhibitor: Naproxen-Sodium (NS) (an analgesic agent) very significantly (P<0.001) reduced the “resting” and “active” pressures and the frequency of cyclic uterine activity of 10 dysmenorrheic patients. It also highly significantly reduced (P<0.001) menstrual pain. Since these effects were observed after a single oral dose of 1100 mg NS, without side effects or complications, extensive field trials are recommended for assessing therapeutic benefits of this treatment.

ACTION OF CARBON DIOXIDE INSUFFLATION OF FALLOPIAN TUBES ON DYSMENORRHEA

Peterson and Cron¹have reported that some cases of dysmenorrhea were benefited by carbon dioxide insufflation of the fallopian tubes. At the time when I²reported some of my own experiences with the insufflation test I had not paid enough attention to the relation of this procedure to dysmenorrhea to venture any opinion. Since that time I have collected fourteen case reports of dysmenorrheic patients whose tubes were insufflated. While this is a small number, it nevertheless shows rather interesting results. Of the fourteen women in the series, eight had had children some years ago and wanted more. Two of these had conceived in a previous marriage but not from their present husbands, and the remaining six patients had never been pregnant at all. Of the fourteen women, one was much benefited by the carbon dioxide insufflation; another was slightly improved; two were better for one or two